IA DHS 470-2844 2021-2024 free printable template

Case #: Date SentEmployer\'s Statement of Earnings Date SSN:Employee\'s Name: Business Name:AOHMAJHKFIFMDJGK ACOICDPOBIACDICK ACLDBHLNAAFHOAFK AKOGMAKMCIOGKCEKForm may continue on to next pageEmployee

How to fill out iowa dhs employer statement

How to fill out Iowa DHS employer statement:

1. Obtain the Iowa DHS employer statement form from the Iowa Department of Human Services website or local DHS office.
2. Fill in your personal information, including your name, address, and contact details.
3. Provide information about your employer, such as the company name, address, and contact information.
4. Indicate the type of employment you have with the employer and specify your job title or position.
5. Include details about your employment start date and anticipated end date, if applicable.
6. Provide information about your work schedule, including the number of hours you work per week and the days of the week you are typically scheduled to work.
7. Indicate your hourly wage or salary and how often you receive payment (weekly, bi-weekly, monthly, etc.).
8. If you receive any additional income or benefits from your employer, such as commissions or bonuses, provide details about them in the designated section of the form.
9. If applicable, indicate whether you have any dependents and provide their names and ages.
10. Review the completed form to ensure all information is accurate and legible.
11. Sign and date the form.
12. Submit the filled out Iowa DHS employer statement to the designated agency or organization that requires it.

Who needs Iowa DHS employer statement:

1. Individuals who are applying for or receiving benefits from the Iowa Department of Human Services.
2. Applicants or recipients of programs such as Medicaid, SNAP (Supplemental Nutrition Assistance Program), TANF (Temporary Assistance for Needy Families), or childcare assistance.
3. Individuals who need to provide proof of their employment and income information to the Iowa DHS or other authorized entities.

People Also Ask about iowa dhs employer statement of earnings

What is the 800 number for DHS in Iowa?

For problems or concerns regarding your local DHS office contact the Central Office at 1-800-972-2017 or by email at contactdhs@dhs.state.ia.us.

What is the number for food stamps in Iowa?

You can report any changes to your SNAP case by calling 877-347-5678.

How do I report an income change to Iowa DHS?

Changes included could be income, address, rent/utility payments, household members, etc. Call 1-877-347-5678 or Fax 515-564-4041.

How do I check the status of my food stamp application in Iowa?

If you submitted an online application, you can Check Your Status online. If you mailed your application or supporting documentation contact the SNAP Retailer Service Center at 1-877-823-4369 to find out the status of your application.

How do I contact Iowa DHS SNAP?

Customer Service Call Centers: Report changes to your Supplemental Nutrition Assistance Program (SNAP), Cash Assistance or Medicaid Case at 1-877-347-5678.

How do I report income change to Medicaid in Iowa?

To report your change by phone, call 1-877-347-5678 between the hours of 7 am and 6 pm Monday through Friday.

For pdfFiller’s FAQs

What is iowa dhs employer statement?

Iowa DHS Employer Statement is a document released by the Iowa Department of Human Services (DHS) for employers. It outlines the requirements and expectations for employers when it comes to providing a safe, healthy, and productive work environment for their employees. The statement also explains the importance of employers understanding their responsibilities when it comes to providing a safe workplace, protecting workers from discrimination and harassment, and complying with state and federal labor laws.

What is the purpose of iowa dhs employer statement?

The Iowa DHS Employer Statement is used to provide proof of employment to the Iowa Department of Human Services (DHS). This statement is used to verify that an employer is in compliance with Iowa's employment and training standards. It is also used to provide information about the employer's wages and benefits, as well as to confirm the employer's contact information.

What information must be reported on iowa dhs employer statement?

The Iowa DHS Employer Statement requires employers to provide the following information: 1. Employer name 2. Employer address 3. Employer contact person 4. Type of business 5. Number of employees 6. Nature of business 7. Date of hire 8. Job title 9. Starting wage 10. Payroll period 11. Hours worked per week 12. Other deductions 13. Type of leave taken 14. Branch location 15. Unemployment claim information 16. Reason for termination 17. Any other pertinent information

Who is required to file iowa dhs employer statement?

The Iowa DHS Employer Statement is required to be filed by employers in the state of Iowa who have employees that are either receiving or applying for public assistance benefits, such as Medicaid or food assistance.

How to fill out iowa dhs employer statement?

To fill out the Iowa DHS Employer Statement, follow these steps: 1. Begin by providing the employer's information at the top of the form, including the name and address of the employer. 2. Next, provide the employee's information, including their name, address, and social security number. 3. Fill in the dates of employment, including the start and end dates for the employee. 4. Specify the number of hours worked per week by the employee. 5. Indicate the employee's hourly rate, salary, or commission. 6. Provide information on any pay increases that the employee received during their employment period. 7. Enter the employer's federal employer identification number (EIN) if available. 8. Indicate the type of work performed by the employee, such as full-time, part-time, temporary, or seasonal. 9. If the employee was on leave during their employment, mark the appropriate box and provide additional information if necessary. 10. Indicate the reason for the employee's separation from the job, whether it was voluntary or involuntary, laid off, quit, or other circumstances. Provide details if necessary. 11. The employer must sign and date the form, providing their title and contact information. 12. If any additional information or explanations are required, you may include them on a separate sheet of paper and attach it with the form. Remember to follow any specific instructions or guidelines provided by the Iowa Department of Human Services (DHS) when completing the Employer Statement.

What is the penalty for the late filing of iowa dhs employer statement?

The penalty for the late filing of the Iowa DHS (Department of Human Services) employer statement may vary depending on the specific circumstances and the discretion of the DHS. However, generally, failing to file the statement by the specified deadline may lead to penalties such as fines and interest charges. It is advisable to contact the Iowa DHS directly or consult with a legal professional for accurate and up-to-date information regarding the penalties associated with late filing.

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